Healthcare Provider Details

I. General information

NPI: 1265348577
Provider Name (Legal Business Name): KYLIE COMBS CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLIE COMBS DANFORTH CIT

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 SHREVEPORT HWY
PINEVILLE LA
71360-3533
US

IV. Provider business mailing address

5505 SHREVEPORT HWY
PINEVILLE LA
71360-3533
US

V. Phone/Fax

Practice location:
  • Phone: 318-441-5900
  • Fax: 318-441-5980
Mailing address:
  • Phone: 318-441-5900
  • Fax: 318-441-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCIT5823
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: